SEEG a RF-TC

SEEG is a minimally invasive neurosurgical procedure primarily used in the pre-surgical evaluation of patients with focal epilepsy, especially those with non-lesional epilepsy—that is, patients whose brain MRI does not show a clear lesion. The goal is to precisely identify the seizure onset zone by recording electrical activity directly from within the brain.

How Is the SEEG Procedure Performed?

• A rigid stereotactic frame is secured to the patient’s head to ensure accurate positioning and prevent movement.
• Based on prior imaging and diagnostics, neurosurgeons plan the placement of 10–20 thin electrodes (similar in size to spaghetti noodles) into the specific brain regions suspected of generating seizures. For each electrode, a small incision is made in the scalp and a tiny hole is drilled into the skull to allow insertion.
• Each electrode is secured with a screw attached to the bone.
• After all electrodes are in place, the frame is removed, and the head is wrapped in bandages.You will not see the electrodes or screws, as your head will remain covered throughout your hospital stay.

How Long Does the Surgery Take?

The surgery takes approximately 1 to 2 hours under general anesthesia. After implantation, you will remain in the hospital for about one week for SEEG video-EEG monitoring.

What Happens During SEEG Monitoring?

Similar to standard video-EEG monitoring, your doctors will try to record seizures.

The difference is that recordings are taken directly from inside the brain, offering much more precise data on where seizures begin.

You will need to remain on bedrest, except when using the restroom.

During your stay, doctors will gradually reduce your anti-seizure medications to increase the likelihood of capturing spontaneous seizures.

SEEG monitoring lasts for approximately one week according to the amount of seizures.

To identify and preserve critical brain functions, doctors may use electrical stimulation of specific brain regions to assess:

• Motor areas
• Sensory areas
• Language centers

This mapping may occasionally trigger a seizure, which also provides important diagnostic information.

Electrode Removal

• Once monitoring is complete, electrodes are removed in the operating room.
• The procedure takes about 15 minutes and is typically performed under local anesthesia or light sedation.
• You will stay in the hospital overnight for observation and be discharged the next day.

If SEEG monitoring successfully identifies a well-defined seizure focus, and there are no contraindications (such as proximity to a major blood vessel or critical brain area), doctors may perform a radiofrequency thermocoagulation (RF-TC) procedure before removing the electrodes.

How Is RF-TC Performed?

RF-TC is typically performed after the completion of SEEG monitoring, once the epileptogenic zone has been identified. A low-intensity current is delivered through selected SEEG electrodes, which thermally ablates the surrounding brain tissue in a controlled fashion.

Jak dlouho RF-TC trvá?

The RF-TC procedure takes only a few minutes and is done in the neurosurgical operating room.

What Outcomes Can Be Expected?

While RF-TC may not be curative for all patients. Complete seizure freedom occurs in approximately 25% of patients, according to the literature.

Even when seizures do not fully resolve, the results of RF-TC often provide valuable clinical information to support the planning of definitive resective surgery.

In summary, RF-TC is a low-risk, targeted treatment option that can be used both as a therapeutic tool and a strategic step in the broader context of epilepsy surgery planning.